331 Fakenham Road is registered to provide accommodation and personal care for up to five people with learning difficulties. There were four people living in the home at the time of our visit.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff understood what protecting people from harm or abuse was, and had received training in this area. Staff understood their roles and responsibilities in keeping people safe and actions were taken when they were concerned about people’s safety. People were safely supported to take their medicines by trained staff.

There were detailed risk assessments within care records concerning risks associated with individuals. These included guidance for staff on how to mitigate these risks. Staff were confident in reporting and recording incidents and accidents should they occur, and taking action when needed.

The appropriate checks and maintenance in relation to people’s living environment were carried out. There were effective processes in place to minimise risk of harm.

Safe recruitment processes were in place to ensure that staff employed in the service were deemed suitable for the role. There were enough staff to keep people safe.

The staff were caring, and we observed positive interactions between people and staff. Staff had good knowledge about the people they cared for and understood how to meet their needs. They supported them to maintain as much independence as possible and to communicate effectively, as well as to maintain their personal relationships.

People could make choices and decisions about their own care, and staff respected people’s privacy and dignity. People were supported to access healthcare wherever necessary and in a timely manner, with prompt action taken in response to changes to a person’s health needs. Staff supported some people to follow their interests and hobbies.

People received enough to eat and drink, and staff supported them to choose what they wanted to eat, and follow a balanced diet. Food and drink was available throughout the day.

Staff understood the importance of gaining people’s consent to the care they were providing to enable people to be cared for in the way they wished. The home complied with the requirements of the Mental Capacity Act 2005 (MCA).

Staff were motivated and spoke positively about their job and understood the importance of providing a high standard of care to the people living in the home. Staff worked well within a team and were supported in their roles.

The registered manager was closely involved with the team, providing support and leadership when needed.

The service had quality assurance systems in place to assess, monitor and improve the quality of care that people received. These included auditing systems and ways of gaining feedback from people.

The inspection took place on 25 September 2015. The provider was given 24 hours’ notice of our inspection.

New Boundaries Group – 331 Fakenham Road provides care for a maximum of five people with a learning disability who may also need support with their mental health. There were four people living at the home at the time of the inspection.

There should be a registered manager at the service. A manager had been appointed who had applied for registration but had not completed the process at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

On the day of our inspection, the person in charge was a deputy manager, newly in post.

At our last inspection on 24 September 2014, we found that improvements were needed to the safety of systems for managing medicines. At this inspection we found that action had been taken to address shortfalls. Systems were in place to manage medicines safely and make sure that people received their medicines when they needed them.

Staff knew how to respond to concerns that someone may be being abused or at risk of harm. The provider had acted on advice to ensure that staff were given further training to enhance their awareness and confidence in reporting such issues. The structure of the staff team had been reviewed to ensure there was a balance of experienced and newer staff who could support people safely and competently. Staff were subject to appropriate checks before they started work, contributing to promoting the safety of people using the service.

Risks to people’s safety were assessed so that staff could take action to minimise them where appropriate. Staff were alert to changes in people’s demeanour that could indicate they were becoming unwell and took action to seek medical advice promptly. However, they did not always consistently adhere to guidance provided by a health professional, designed to address risks to a person’s health.

Staff had a basic understanding of how to support people to make informed decisions about their care but people’s abilities to make specific decisions were not always clearly assessed. The management team knew when they needed to take action to review this, to ensure people’s rights and freedoms were not unnecessarily restricted or infringed.

Staff had developed good, caring relationships with people and took action to promote their privacy and dignity. They were aware of people’s interests and preferences and took these into account when assisting people with their activities. Activities were being further reviewed to ensure that they were meaningful and fulfilling for people.

There had been frequent changes in the management and leadership of the service and further changes were proposed. The proposed changes should ensure a more ‘visible’ management presence in the home and the incoming senior staff had already identified some improvements that were needed. However, the lack of consistency and stability of leadership had compromised the ability of the provider to demonstrate that improvements would be made and sustained as they intended.

Systems were in place for checking and monitoring the quality and safety of the service but had not identified the failing that we found in that specialist dietary advice was not being followed. As a result, action had not been taken to explore a person’s understanding of the risk, their rights, and the staff team’s duty of care.

This inspection was carried out by a single inspector. Four people were using the service at the time of our inspection. As part of our inspection we spoke with three people who were receiving support, three relatives, the manager, and four staff working at the service. A registered manager was in post at this service. We also observed people receiving support and looked at the support plans for three people. We used the evidence collected during our inspection to answer five questions.

Is the service safe?

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Risk assessments regarding people's individual activities were carried out and measures were in place to minimise these risks.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Appropriate checks were undertaken before staff began work.

The provider had a system in place to demonstrate that they had given consideration to whether each person using the service had the capacity to make decisions about their day to day care under the Mental Capacity Act (2005). The Mental Capacity Act is a law which requires an assessment to be made to determine whether a person can make a specific decision at the time it needs to be made. It also requires that any decision made on someone’s behalf is recorded, including the reasons why it has been made, how the person’s wishes have affected the decision and how they were involved in the decision making process. The provider was taking appropriate action to ensure that people’s rights were protected by appropriate consideration and use of the Mental Capacity Act and the Deprivation of Liberty Safeguards.

Is the service effective?

People we spoke with told us that they were happy with the service which they received. The relative we spoke with told us that the service met the needs of their family member.

Staff were knowledgeable about people's individual health and wellbeing needs. They worked closely with health professionals to ensure that people’s needs were met.

The care plans were personal to each individual and were reviewed on a regular basis. Assessments of any potential risks to people had been carried out and measures put in place to reduce the risks.

Staff told us they received a very good level of training and felt equipped to undertake their role at the service. Staff expressed some concerns about the level of staffing at the service, as on some occasions, the service was supported with staff who did not usually work at the service.

Is the service caring?

People who used the service told us that they liked the staff and they thought they were friendly and caring. We saw that people had a positive relationship with the staff who supported them. We spoke with three relatives who said that they found the staff to be caring and felt they understood the needs of their family member.

We observed how staff spoke with people using the service and how they supported people. We saw that this was done in a respectful way. We saw that staff were friendly and approachable and encouraged people to be independent . Staff supported people to engage in meaningful activities. We saw that people were involved in making choices about various aspects of their daily life.

Is the service responsive?

People's individual physical, emotional, psychological and social care and support needs were assessed and met. This included people's individual choices and preferences as to what they would like to eat and how they liked to spend their day.

People’s needs and care plans were regularly reviewed by the staff and management at the home. Referrals were made to health professionals to ensure that people received appropriate support by people with the most appropriate knowledge and skills.

Support plans included information on people’s likes and dislikes and their preferences, to ensure care and support was delivered taking into account their personal preferences. The staff we spoke with told us they were trained to do their job and knew how to meet the needs of people using the service.

People participated in a range of activities which suited their individual choice. They were supported to participate in activities within the local community. Staff promoted the independence of people who used the service.

Is the service well led?

The service had a registered manager in place. The manager had been in post for about six months prior to the inspection.

Staff told us that on some occasions they did not feel supported by the management team and the provider. They said they did not always feel listened to and felt that support could be improved. Over the previous months there had been many changes at the service and staff felt unsettled.

Staff told us they received regular supervisions and appraisal meetings. We saw evidence of notes of these kinds of meetings.

The relatives we spoke with told us they felt the service was well-managed. They said they were confident to raise any concerns or complaints they had with the manager. The manager and staff maintained positive and frequent contact with relatives of people who used the service.

The provider had effective quality assurance and audit systems in place to monitor the service and ensure improvements were made where necessary.

We spoke with two people living in the home. However, because of anxiety around strangers it was not easy to gather people's views verbally. For this reason we listened to how staff interacted with people and looked at notes from 'service users' meetings. We also looked at the results of surveys of relatives who had responded with their views about the service.

We asked one person what they thought about the home. They said it was "...good." Records from meetings showed that people were asked about what they wanted to do and to eat. Staff had training to help them understand how to support people with making informed decisions and what to do if people could not make informed decisions about their own care and treatment. Relatives’ surveys showed that they felt the care was good or very good and that the manager gave them time for discussions if they had any concerns.

People were able to move around the home freely and use any of the communal areas or their own rooms. The safety and maintenance of the home was checked regularly.

Staff understood people's needs. There were enough of them to support people consistently and to assist people with their chosen activities. Plans to reorganise the starting times for staff shifts had been made so that people's preferred routines were better met.

There were some systems for monitoring the quality and safety of the service. However, there was no evidence of consultation with people living and working in the home as part of this and some assessments of risks to ensure the safety of people living and working in the home had not been updated.

People told us that they were happy with the support they received from staff. They said no one was rude to them. Two people gave us details about the kinds of things that staff had helped them with in their daily lives. They also told us staff supported them with their long term goals and helped them feel better about themselves.

One person said, "It's really cool. I like it here". People told us that the staff were approachable and they could raise issues that bothered them.